A study of peripheal nervous system alterations in hypothyroid patients

Deepayan Das; Sibaprakash  Mukherjee; Shubhrangsu Samanta; Ajay Babu Kannabathula

doi:10.53730/ijhs.v8nS1.15471

Authors

Deepayan Das Associate Professor in Physiology, SRIMS & SH, DURGAPUR
Sibaprakash Mukherjee Associate Professor in Physiology, SRIMS & SH, DURGAPUR
Shubhrangsu Samanta Associate Professor in Anatomy, SRIMS & SH, DURGAPUR
Ajay Babu Kannabathula
ajaykbabu57@gmail.com
Professor in Anatomy, SRIMS & SH, DURGAPUR

Keywords:

Hypothyroidism, Nerve conduction study

Abstract

Introduction: Hypothyroidism is an endocrine disorder of deficient thyroid hormone levels in the circulation. Thyroid hormones are essential for the normal functioning of the brain and nervous system^.One of the manifestations of the hypothyroidism is the peripheral neuropathy. Methods: This cross sectional study includes 30 hypothyroid patients and 30 normal subjects between the age group of 20 to 60 years. The nerve conduction study was done by using Recorders Medicare System (RMS) EMG EPM2K version-1. Three parameters (latency, amplitude and nerve conduction velocity) of motor and sensory component of three nerves (Median nerve, Ulnar nerve and Peroneal nerve) were compared between cases (Hypothyroidism) and controls (non hypothyroid). Statistical analysis was done by unpaired ‘t’ test and ANOVA with SPSS software for various analysis. Results: The nerve conduction velocity is reduced in right median, right and left ulnar and left common peroneal nerves. The latency is prolonged in the right and left ulnar nerve as well as in the peroneal (both right and left) nerve. The amplitude of the nerve conduction action potential of the all the nerves is not significantly reduced. The sensory nerve conduction velocity of the sural nerve is reduced in our present study.

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References

Arthur C. Guyton John E. Hall,In : insulin glucagon and DM, Text book of Medical Physiology, 11 th edition, 2006 Saunders, Philadelphia:972

G.K. Pal, PravathiPal , In: The Thyroid Gland, Textbook of Medical Physiology, 2ndEdition,2011, Lipee Scan Private Ltd, pg-352

Lewis E. Braverman, In: The heritage of the thyroid; A brief history, Werner &Iingbar’s the thyroid a fundamental and clinical text, Tenthedition, 2013, Wolters Kluwer/ Lippincott Williams & Wilkins. Pg- 1.

John A.H.Wass, Stephen M.Shalet and Jayne A.FranklynIn:Subclinical hypothyroidism; Oxford Textbook of Endocrinology and Diabetes. 2002. Oxford University Press. Pg 286.

GulbunYuksel, Geysu Karlikaya, Tulin Tanridag, Onder US, GulserenAkyuz. Nerve Conduction Studies, SEP and Blink Reflex in recently diagnosed, Untreated Thyroid Disease Patients, Journal of Neurological Sciences 2007, volume 24, Number 1, Page 007-015.

Golding N N. Hypothyroidism presenting with musculoskeletal symptoms. Ann.rheum.Dis.,1970:10-14. DOI: https://doi.org/10.1136/ard.29.1.10

Peter D Donofrio, In: Clinical Approach to a patient with Peripheral Neuropathy, Text book of Peripheral Neuropahy, 2012, Demos Medical Publishing.Pg-1.

MoosaA, and Dubowitz V. Slow nerve conduction velocity in cretins. Archeves of Disease in childhood,1971,48,852. DOI: https://doi.org/10.1136/adc.46.250.852

Dyck PJ, Lambert EH. Poly neuropathy associated with hypothyroidism. J NeuropatholExp Neurol.1970,29:631-658 DOI: https://doi.org/10.1097/00005072-197010000-00008

Shirabbe T, Tawara S, Tetrao A, Araki S. Myxedematous polyneuropathy: a light and electron microscopy study of peripheral nerve and muscle. Journal of Neurology, Neurosurgery, and Psychiatry 1975; 38: 241-247. DOI: https://doi.org/10.1136/jnnp.38.3.241

Meier C, Bischoff A. Polyneuropathy in hypothyroidism clinical and nerve biopsy study of four cases. J Neurol 1977;213:103-104. DOI: https://doi.org/10.1007/BF02402143

Pollard JD, McLeod JG, Honnibal TGA, Verheijden MA. Hypothyroid polyneuropathy.J Neurol Sci 1982;53:461-71 DOI: https://doi.org/10.1016/0022-510X(82)90243-X

Ruurd F Duyff, Joan Van den Bosch, D Martin Laman, Bert-Jan Potter van Loon. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Journal of Neurology, Neurosurgery,Psychiatry 2000;68:750-755. DOI: https://doi.org/10.1136/jnnp.68.6.750

WilsonJ, Walton J. Some muscular manifestations of hypothyroidism. JournalofNeurology,Neurosurgery,Psychiatry1959;320-324 DOI: https://doi.org/10.1136/jnnp.22.4.320

Fessel, W.J. Myo pathy of hypothyroidism Ann.rheum.Dig.,1968;590. DOI: https://doi.org/10.1136/ard.27.6.590

Nickel ,S.N.,Frame, B., Bebin , J., Tourtellotte, W. W., Parker, J. A.,and Hughes, B. R.1961.Myxedema neuropathy and Myopathy. A clinical and pathologic study. Neurology (Minneap), 11, 125-137 DOI: https://doi.org/10.1212/WNL.11.2.125

UK Misra, J Kalita In: History of Clinical Neurophysiology. Clinical Neurophysiology. 1stEdition 2005, Elsevier, New Delhi 1-7.

Eslamin F, BahramiA, Aghamoh ammadzadeh N, Niafar M, Salekzamani Y, Behkamrad K. Electrophysiologic changes in patients with untreatedprimary hypothyroidism. J ClinNeuriphysiol. 2011 Jun;28(3):323-8 DOI: https://doi.org/10.1097/WNP.0b013e31821c30d9

MarciaW.Cruz; MauroTendrich, MarioVaisman, Sergio A. P. Novis. Electroneuromyography and neuromuscular findings in 16 primary hypothyroid patients; ArqNeuropsiquiatr 1996, 54(1): 12-18.

Paola Penza. Raffaella Lombardi. Francesca Camozzi. Claidia Ciano. Giuseppe Lauria. Paimful neuropathy in subclinical hypothyroidism:clinical and neuropathological recovery after hormone replacement therapy. NeurolSci (2009)30:149-151. DOI: https://doi.org/10.1007/s10072-009-0026-x

Colin D. Binnie, Ray Cooper, C.J.Fowler and B.M.TedmanIn:Clinical neurophysiology, volume I . Second edition 2004.EMG, Nerve conduction and Evoked potentials. page 1

Giroud M, Tenenbaum D, D’Athis P, Dumas R, Nivelon JL. neurophysiological study of peripheral nerves in newborn infants with congenital hypothyroidism. Value in the surveillance of replacement therapy. Arch FrPediatr. 1988 Mar;45(3):175-9

Ellen Crushell , William Reardon . Elevated TSH levels in mentally retarded boy. European Journal of Paediatrics; 2010:573-575.) DOI: https://doi.org/10.1007/s00431-009-1075-0

Indukhurana: In: Thyroid gland: Textbook of Medical Physiology; First Edition, 2006, Elsevier, Pg-718

Colin D. Binnie, Ray Cooper, C.J.Fowler and B.M.TedmanIn:Clinical neurophysiology, volume I . Second edition 2004.EMG, Nerve conduction and Evoked potentials. page 41-45

Somay G, Oflaxoglu B, Us O, Surardamar A. Neuromuscular status of thyroid diseases: a prospective clinical and electrodiagnostic study. ElectromyogrClin Neurophysiol.2007 Mar-Apr; 47(2):67-78.

A.K. Thacker, DilipAgarwal and N.B.S. Sarkari. Bilateral anterior tibial compartment syndrome in association with hypothyroidism. Postgrad Med J (1993) 69, 881-883. DOI: https://doi.org/10.1136/pgmj.69.817.881

Yuksel e. Somatosensory evoked potential and Blink reflex in newly diagnosed and untreated thyroid disease patients. Journal of Neurology, Neurosurgery, Psychiatry 2000; 68:850-855.

MagriF,BuonocoreM,OlivieroA,RotondiM,Gatti A, Accornero S, Camera A, Chiovato L. I ntraepidermal nerve fiber density reduction as a markerof preclinical asymptomatic small-sensory neuropathy in hypothyroid patients.

Suresh E, Morris IM. How valuable is screening for thyroid disease in patients with carpal tunnel syndrome? J ClinRheumatol. 2004 June;10 (3):116-8. DOI: https://doi.org/10.1097/01.rhu.0000130859.10006.27

Lai CL, Lin RT, Tai CT, Liu CK, Howng SL. Astudy of central and peripheral nerve conduction in patients with pripmary hypothyroidism: the effect of thyroxine replacement. Kaohsiung J Med Sci.19998 May;14(5): 294-302.

Cruz MW, Tendrich M, Vaisman M, Novis SA. Electroneuropathy and neuromuscular findings in 16 primary hypothyroidism patients. Arg Neuropsiquiatr.1996 Mar; 54(1): 12-18. DOI: https://doi.org/10.1590/S0004-282X1996000100002

EttoreBeghi, Maria Lelodovici,GraziellaBogliun, VottorioCrespi, FelicePaleari, PIERLUIGI Gamba, Maurizio Capra,MicheleZarrelli. Hypothyroidism and polyneuropathy. Journal of Neurology, Neurosurgery and Psychiatry 1989; 52:1420 – 1423. DOI: https://doi.org/10.1136/jnnp.52.12.1420

RaffaelloNemni, Edo Bottacchi, Rarraella Fazio, Angelo Mamoli, Massimo Corbo, Massimo Camerlingo, Giuseppe Galardi, Luciano Erenbourg, Nicholas Canal. Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases. Journal of Neurology, Neurosurgery and Psychiatry 1987; 50: 1454-1460. DOI: https://doi.org/10.1136/jnnp.50.11.1454

Yeasmin S, Begum N, Befum S, Rahman SMH. Sensory Neuropathy in Hypothyroidism: Electrophysiological and Clinical Findings. Journal of Bangaladesh Society of Physiology.2007 Dec ;( 2):1-6. DOI: https://doi.org/10.3329/jbsp.v2i0.975

Jane Martin, G H Tomkin, Michael Hutchinson. Pripheral neuropathy in hypothyroidism – an association with spurious polycythaemia (Gaisbock’s syndrome). Journal of the Royal Society of Medicine. Volume 76, March 1983, 187. DOI: https://doi.org/10.1177/014107688307600306

Adriana PatricaSuraniti, Liliana Rosa Gilardoni, Maybel Graciela Ramallal, Marcelo Echevarria, Mary Marcondes. Hypothyroid associated polyneuropathy in dogs: Report oc 6 cases. Journal of vet. Res. anim. Sci, volume 45, number 4, Pg 284-288. DOI: https://doi.org/10.11606/issn.1678-4456.bjvras.2008.26687

Michael J. AminoffIn:Nerve Conduction Studies; Electrodiagnosis in Clinical Neurology 2005. Fifth Edition. Elsevier, Pg 285 DOI: https://doi.org/10.1016/B978-0-443-06647-4.50018-5

Thomas H Brannagan, Louis H Weimer and Norman Lator. Acquired neuropathies. In Merritt’s neurology, 11th edition, Lewis P. Rowland, Philadeiphia: 761.

Khedr E.M., El Toony L.F., Tarkhan M.N., Abdella G. Peripheral and Central nervous system alterations in Hypothyroidism: Electrophysiological Findings. Neuropsychobiology., 41(2):88-94 DOI: https://doi.org/10.1159/000026638